A: The charts show a temperature up to 37.83 centigrade in thirsting.
Q: Professor, is it well-known that after the administration of a hypotonic table salt solution temperature rises occur?
A: Yes.
Q: Professor, would you, therefore, if such sub-febrile temperatures occ** in a condition of thirst, think that it was justifiable to consider such an experimental subject ill or seriously ill?
A: It means that they are considerably dehydrated.
Q: Professor, I believe that these records of Dennig's experiments show that temperatures were observed already on the first and second days.
A: In the experiments in this article?
Q: Yes.
A: According to my interpretation of the charts, on the 3rd and 4th days
Q: I think that I can remember that in one experiment on the first day there was already a temperature over 37 degrees centigrade.
A: Perhaps.
Q: Professor, is dehydration a condition of lack?
A: Yes.
Q: And does the administration of liquid do away with this lack?
A: The administration of water alone may not do away with the lack; it may require water plus a little salt.
Q: Thus you would consider it expedient in such a case to use salt solutions?
A: Yes, hypotonic.
Q: Professor Ivy, do you know a report in medical literature according to which lasting damage was observed with certainly after a thirst condition was removed?
A: Thirst alone; no.
Q: Do you know such a report as a result of the drinking of seawater?
A: No, except in those cases on a raft at sea, who drank seawater, developed hallucinations, and walked or jumped overboard or died.
Q: Professor, I believe that you have misunderstood me again. I asked you whether after the rescue, that is, after they had been given fresh water, an observation of permanent damage has so far been published in any world medical literature?
A; I know of no articles in which, after subjects have experimentally taken seawater in small amounts for short periods of time, have manifested any permanent damage.
Q: Professor, is it correct that during the condition of thirst, due to the thickening of the blood, that is, due to the fact that the blood loses water, the circulating amount of blood is reduced?
A: Yes, the blood volume is reduced.
Q: Yes. Professor, from the records of my experiments could you convince yourself that the pulse frequency during the experiment showed a tendency toward reduction?
A: Yes, as I recall, there was a tendency to a reduced rate.
Q: Professor, if the blood volume is reduced and the frequency of the pulse does not increase, is it correct that the minute volume of the heart is reduced?
A: Yes.
Q: Professor, after the heart has adjusted to this smaller minute volume, and after a sudden intravenous administration of liquid of about 1/3 of the volume, would you help that heart with a stimulant?
A: I should not.
Q: But can you imagine that a practicing physician would consider such a thing?
A: Well, perhaps, depending upon the general condition of the patient.
Q: Professor, from the fact alone that a stimulant is used, can one conclude with certainly that there was a weakness of the heart?
A: I do not believe that you can.
Q: Professor, is it correct that one of the symptoms of weakness of the heart is rather a faster pulse rate than a slower one?
A: Yes.
Q: Professor, I believe you have also carefully studied the values for blood pressures which I recorded. Could you convince yourself that in all cases the blood pressure was normal after the experiment?
A: Do you mean after the experimental period?
Q: Yes, that is what I mean.
A: As I recall, there was a tendency for the blood pressure to be normal, although in some cases it was somewhat below what it was before, but not strikingly so.
Q: Did you compare the blood pressure before the experiment with the blood pressure after the experimental period?
A: Yes, that is what I had in mind.
Q: And in doing so you found that the blood pressure at the end of the experimental period was the same as that before the experiment?
A: Essentially so, on the average.
Q: Later I shall come back to those cases which were described as seriously ill here, and I shall discuss the blood pressures in those cases. Professor Ivy, if I tell you that Sterofundin is nothing but Ringer solution, do you still consider it justified, if Sterofundin is used than a thirst experiment is interrupted, to conclude that it was a serious illness?
A: No, I should not conclude that it was, because ...
Q: Professor, ...
THE PRESIDENT: The witness may complete his answer to the question. It was interrupted.
A: No, I should not conclude that because Sterofundin is used the patient, after a thirst experiment, necessarily was in a serious condition; but one wonders why, in such experiments, the material was given intravenously rather than orally.
Q: That was administered because an intravenous administration of salt solution, in accordance with all of the statements in medical literature known to me, influences the liquid content of the body more permanently.
MR. Mc HANEY: I ask that the remark of Dr. Beiglboeck be stricken. He is going on direct examination. He can testify at that time.
THE PRESIDENT: The remarks of the witness were in the nature of testimony on his part rather than a question to the witness. His remarks will be stricken from the record. He will be permitted to take the stand again and make what statements concerning his own actions he desires.
Q: Professor Ivy, would you say that after an intravenous injection of Ringer or table salt solution, chills with sharp rises of temperature are sometimes observed?
A: Not when the technique is good. I have never seen chills and temperature after an intravenous injection of Ringer Solution or sodium chloride solution if the tubing is free and if the solution is free of pyrogenic substance, that is, triple redistilled water is used to be sure that there is no temperature - inducing substance in the water.
THE PRESIDENT: The Tribunal will now recess until 1:30 o'clock.
(A recess was taken until 1330 hours).
AFTERNOON SESSION (The hearing reconvened at 1330 hours, 16 June 1947)
THE MARSHAL: The Tribunal is again in session.
THE PRESIDENT: The Secretary General will file for the record the certificate as to the illness of defendant Oberheuser signed by the prison physician which has been received. The examination of the witness may proceed.
DR. ANDREW IVY - Resumed CROSS EXAMINATION (Continued) BY DEFENDANT BEIGLEBOECK:
Q. Professor, is it true that on the first day of a hunger-thirst experiment there is a considerable loss of weight?
A. Yes.
Q. Professor, I ask you to take a lock at the case records of cases 1 to 32 and to assure yourself that the weights between the 20th and 22nd of August either remain the same or increase somewhat and that from the 22nd to the 23rd of August in all of these cases there is a palpable loss of weight.
A. I looked at the first three charts and I fail to find a weight recorded on the 21st. I find a weight on the 20th, the next weight on the 22nd.
Q. Professor, wouldn't it be nonsensical to begin such an experiment without taking the weight on the first day?
A. Yes, I should say so.
Q. Professor, let me ask you to take a look at Case 1; on the 20th, 64.5; on the 22nd, 64.7, and on the 23rd, 62.2 are the respective weights. Is that correct?
A. Yes.
Q. If the experiment had begun on the 21st should one not assume that from the 20th to the 21st a gain in weight of about two kilograms would have taken place?
A. Did you say a gain of two kilograms?
Q. Presupposing that the experiment began on the 21st; so that the weight on the 22nd is determined already twenty-four hours after the hunger and thirst began, then from the 20th to the 21st the man myst have gained about 2 kilograms.
A. Yes, I understand. Yes, because the weight on the 20th is 64.5 kilograms and on the 22nd, 64.2, is the same; hence, there has been apparently no loss of weight between August 20th and August 22nd.
Q. Then, Professor, should you not assume that the experiment begain the 22nd if from the 22nd to the 23rd in this case more than 4 points are lost?
A. Yes.
Q. All the cases from 1 to 32 show the same phenomenon as regards the weight, I ask you, please, to look through the charts and assure yourself of that fact briefly.
A: There are some sheets missing.
Q: Professor, so far as I know the file is complete. They were all discussed here before the Tribunal.
A: I cannot find all of the sheets. For example under subject No. 32, the preperiod data are missing. I can answer your question, yes, up to subject No. 32.
MR. HARDY: I do not believe that the charts and subjects, that then No. 32 contained the first weight, I do not recall when I was questioning Beiglboeck that the chart then contained that and that they started out the first day of the experiment. Maybe that may be helpful.
BY DEFENDANT BEIGLBOECK:
Q: From the 32nd to the 44th, the experiments began on the 1st of September, and the other experiments began on the 22nd of August. I am asking you now whether the experiments began on the 21st or 22nd, and for that reason I shall ask you to look at the individual case records and to compare the weights and to tell us whether the experiments began on the 21st or the 22nd.
A: According to the weight records up to subject No. 32, which is as far as I have been able to follow the cases, indicates that the experiments started on the 22nd. For example on subject No. 32, on page 32, the first date apparently is August 22nd and the weight was 67.1 kilos, and on the 23rd it was 65.4, indicating that the experiment may have started on August 22nd.
Q: Professor, is it so that you can only test the Romberg reflex on someone who is able to stand?
A: According to my knowledge of that test, the way I perform it, it is necessary for the subject to stand.
Q: Then in a deeply unconscious state a subject could not be given the Romberg test?
A: That is correct.
Q: Professor, do you think a person who is deeply unconscious can ask for water.
A: That depends upon whether they are so unconscious that they cannot speak. An unconscious person can ask for water.
Q: Professor, in the usual linguistic usage in German medicine the word "coma" means a total unconsciousness, such as in a come diabeticum. I don't know whether the word "coma" in English usage has a wider meaning. Could you please tell us whether you understand the words "Comatose" and "unconscious" to be synonomous?
A: No, unconscious and comatose are not synonomous according to the way I use the terms.
Q: Then you think that the condition here described is not one of deep unconsciousness?
A: What words do you have reference to?
Q: I am referring to the case in which it is said that the Romberg test is positive and that the man is in a semi-conscious state. I want to ask if you agree with me that according to medical linguistic usage the state being referred to here is one of somnolence?
A: That depends upon the meaning of a two plus Romberg. I believe that was your question. I am not accustomed to saying that a Romberg sign is two plus so it may be that the two-plus Romberg could mean that the individual could not stand but when attempting to stand would fall over to the ground so I don't know the meaning of the two plus Romberg.
Q: Professor, let me tell you that the two-plus sign is used when the reflexes can be tested and are strongly positive. Can the Eschner eyeball reflex be tested on a healthy person?
A: Will you repeat the question?
Q: Can you use the eyeball pressure reflex according to Eschner on health persons?
A: I don't know what a reflex is according to Eschner.
Q: This is a reflex that affects the rate of the pulse when pressure is exercised on the eyeball.
A: Yes, you can try that test both on conscious and unconscious persons.
That was ay understanding of the meaning of the eyeball reflex, but I had not heard the expression "according to Eschner".
Q: It is usually so designated in Germany Professor. You still have the charts before you. Please let us go through a few of these cases together and I want to ask you whether it is your opinion that in these cases water, to wit, fresh water, as drunk. Please turn to case No. 3. Do you think that this patient from the 26th to the 27th and from the 28th to the 29th drank some fresh water, if from the 28th to the 29th he loses only 300 grams weight?
A: That is a small loss of weight which is consistent with taking in some water. The small urinary output, however, is hardly consistent with taking in some water, and when one is quite thin to begun with the loss of weight becomes relatively small after four or five days of fasting.
Q: Professor, where the amount of urine is 250 cc and the total loss of weight is 300 cc, one is forced to a conclusion that the man would have lost only 30 grams through perspiration and through respiration, now that is not very probable, is it?
A: No, it is not very probable and my interpretation was that he probably got some water.
Q. Do you agree with me, professor, when I say that the first reaction of a thirsting person when drinking water is retention?
A.- Yes, that is true.
Q.- Would this explain the slight amount of urine?
A.- This is consistent, yes, with that explanation.
Q.- In order not to take up too much time I should like to ask you to tell me in the other cases I am going to put to you whether you agree with me that when the person is receiving 500 cc of sea-water a day and is fasting as well, is it not so that one must count a minimum loss of weight of 500 cc a day?
A.- Yes, I agree with that generalization. I might say for the sake of the record in making these predictions whether the subject did or did not gain access to water that I should prefer to see the blood chemistry.
Q.- The blood analyses are available. But I just wanted to ask this - take a look at case 18 - for three successive days weights vary from 51.6, 51.5 and then again 51.5. Now in this case cannot sno say with absolute certainty that the person has been drinking considerable amounts of fresh water?
A.- I should agree.
Q.- Is the dullness heard when tapping the liver a pathological symptom in and of itself? Or, let me put it this way, if in a case history you find a notation that states the liver is the way it was before, would you regard that as a pathological pehnomena on?
A.- That question is not clear to me.
Q.- In one of these charts I noted "Liver not enlarged, liver dullness as before" and the Prosecution construed this to be a pathological symptom.
A.- That would indicate to me that the liver was the same as it was before.
Q.- Professor, you have brought up a large number of cases here in which you have been of the opinion that it could be deduced that severe injury had been done, and possibly permanent injury resulted there from.
Please tell me whether you think that in those cases where the subject's weight on his release from the experiment has returned to its previous statue or has even increased a bit - now, in such a case don't you feel that the experimental subjects will recover completely after the experiment? - I am referring, for instance, to case No. 21.
A.- I gave a rather long list of subjects in which I said an interpretation of the records would permit the deduction that they were quite sick at the termination of the experiments. However, the list that I gave for those who were quite sick and in whom death might have occurred was rather short. As I recall I gave a list of only three such cases. Now referring to case No. 21.
Q.- There you will find that on the 14 of August his weight was 54 kilograms - is that not so?
A.- Yes.
Q.- Now will you please look at his weight when he was released?
A.- When he was released the weight was 54.2. But one may wonder how much of that increase of weight is due to retention of water by the body. It is possible that the patient may have received so much water or fluids that was retained or a large amount of that was retained and accounts for the return of weight to the normal level of 54. I do not see any urinary outputs in this particular subject on August 29, August 30, 31st and September 1, 2 and 3.
Q.- Professor, two weeks after the end of the experiment, on 12 September, the weight is still set down there in the chart. In the upper right hand part of the table.
A.- Do you have reference to D 12/9/44 - 57.5 kilograms?
Q.- That's right, yes.
A.- The weight of 57.5 kilograms is indicated for the 12th September.
Q.- Professor, would you not construe this as an indication that the man has completely recovered since after more than two weeks after the conclusion of the experiments his weight stands so high?
A.- Yes, I accept that as an indication but I should like to know the urinary output on the days particularly immediately following the experiment so as to see this increase in weight was not due to oedema.
DR. STEINBAUER: I should like to ask that the two smaller booklets which the Secretary General his may be shown as well as the fever charts.
THE PRESIDENT: Are the booklets available in the Tribunal?
DR. BEIGLBOECK: The urinary output is certainly set down in the booklets, for that period 7 to 12 September.
MR. HARDY: We recall, your Honor, that during the course of cross examination we found, that some of the urinary outputs were not contained in the books either.
DR. STEINBAUER: The Secretary General has had these books in his possession all the time; we have not had them since the beginning of the cross-examination.
BY DR. BEIGLBOECK:
Q.- On the 26th, the urinary output is 1,080, which is a considerable amount of elimination for a person who has just been thirsting. Professor, in case 23, you concluded from the acute gain in weight after the experiment that injury had been done? Was it your opinion that this was a case of oedema? Case 23 from the 30 to the 31 August?
A.- It was difficult for me to understand how the body weight could increase from 53.8 to 62.8 from the 30 to the 31st.
Q.- Perhaps I have made a mistake here. I have 59.8 and 62.8 as the two weights in question.
A.- Under the date of 29th there are two weights, 60.3 and 59.8, the latter is in pencil. On August 30, according to the figure as I read it it is 53.8 and on August 31st it is 62.8 and on September 1 61, and on September 2 62, and on September 3 62.9.
Q.- That is probably not 53.8 but 59.8. These are pencil notations, is that not so? The increase from 59.8 to 62.8 led you to look upon this as something pathological. Now, will you please follow the course of the weight here and conclude that some error was made in the weighing, either the patient drank a lot of water just before the weighing or an error was made by the recorder?
A.- Yes, that is possible.
Q.- You don't consider it probable that a case of oedema existed here because excretion the next day would have been improbable?
A.- Well, it is true that the excretion the next day was larger than the input but that does not mean that some oedema may not have been present. How extensive the oedema is, is hard to say and I am willing to agree that the figure 53.8 is an error in copying down the weight because it is difficult to believe that the patient may have lost that many kilograms in 24 hours and then jumped up to 62.8 the following 24 hours.
Q Professor, if an X-ray photograph shows that the pieces of the lung show a shadow which is not relieved by coughing and that the hilus of the lungs is thickened on both sides and is fibrous, would you not concur in my opinion that this X-ray shows simply that there is a certain pleural thickening of the pieces of the lungs, that there is a scar on the pieces of the lungs?
A That is possible. As I explained in my direct testimony I should have to see the X-ray films myself before I could base an interpretation on them or answer that question with any degree of accuracy.
Q But you do agree with me that this X-ray does not necessarily show a new process taking place in the lungs?
A I agree with that.
Q Professor, when you looked through my experimental records, did you look at Case #7?
A Yes, I looked at the record on every subject.
Q This is a case that was treated with Schaefer water. This experimental subject was in the experiment for twelve days, fasting for eight, and lost 4.8 kilos throughout the experiments from the 22nd to the 2nd of September. Is that not so? From 61.5 on the 22nd to 57 on the 2nd of September.
A Yes, and then on the 3rd of September, the patient apparently still lost some more weight.
Q Is the final weight of this experimental subject - namely, 60.5 is it the same as the person's weight roughly when he entered the experiment?
A Yes.
Q Then you would say that the subject had recovered from this fasting cure?
A Yes, on the basis of the information available.
Q In Case 3. Professor, please look in this notebook for the blood pressure record at the conclusion of the experiment - namely, on the 29th - and tell me if these blood pressures are normal?
On 30 August the blood pressure is 114 over 70, in case 3.
A Yes, that is normal.
Q On the 1st of September, under the influence of strychinine which the man took, the blood pressure is somewhat higher, 136 over 90?
AAre you referring to Subject 3?
Q Yes.
A I am sorry, I don't find that.
Q It's not on the chart.
A On the pages that you had indicated with this white sheet of paper, after Subject 3. on the 30th, I find a blood pressure of 119 systolic and 80 diastolic, and then the next record, that is on the 31st, 136 over 90. The next record is.... Is that what you have reference to?
Q Yes, that's what I am referring to.
And on the 2nd of September is there a record of blood pressure?
A Yes, 120 over 76 - pardon me, it's 119 over 70, and then the space after that is blank and nothing is written in.
Q Are those normal blood pressures, Professor?
A Yes.
Q Is it not possible, Professor, that in this case the strychnine was really given as a tonic for the intestines because the man was constipated and was afraid that this would last, so the strychnine was here administered, not as a stimulant to the circulation, but as a tonic for the intestines?
A I have never heard of strychnine being so used.
Q I can only tell you that in our clinic strychnine was very often used as an intestinal tonic, but perhaps that isn't the general practice.
Now, Professor, I don't want to go through every case separately now, but I have one brief question.
Are you of the opinion that intensified vesicular respiration indicates bronchitis?
A Yes.
Q Must one not assume that a thirsting person would excrete roughly 400 cc of urine a day?
A Yes.
Q And if such a thirsting person can concentrate 2% salt solution do you not agree with me that you can give him as much as eight grams of salt?
A Yes, that is a reasonable assumption.
Q Now, Professor, if a person receives roughly 15 grams of salt, which would correspond to about half a liter of seawater, then he would eliminate roughly 800 cc a day of urine? Is that not so?
A Yes, that's approximately correct.
Q Thus, any one who received this amount of salt would be worse off than a person thirsting?
A Yes.
Q However, if he receives this in the form of 500 cc of sea water he would, nevertheless, save 100 cc as compared with the thirsting person.
A Yes, that's theoretically possible.
Q Professor, do you know that the experiments carried on by Ledell and Edington and Winkler led to the conclusion that small amounts of sea water, because of this slight saving of water, are better than complete thirst?
A Yes, with that idea in mind I have made a study of the question of the extent to which one may stretch fresh water by adding sea water to it, and a small quantity of sea water may be ingested with saving, according to theoretical considerations, and according to the observations of Ledell and ourselves. The extent of the ability of different individuals to tolerate the additional seawater to the fresh water varies.
Q Then, you remember, Professor, that Ledell observed that two experimental subjects were capable of a concentration of salt higher than 2%?
A Yes, and I recall in my direct testimony, I said that since I had not seen that myself in my own experiments, I have wondered whether or not there might not be an experimental error in the case of the figure 2.3%.
Q Professor, am I right in spying that between your experiments, so far as I know them, and Ledell's experiments this difference exists - namely, that Ledell first created a certain status of dehydration before he gave seawater to be drunk?
A Yes, that's correct.
Q Then, is it not possible that a dehydrated body is capable of a better kidney concentration than a body that has enough water available to be a little luxurious in its elimination of the salt concentration?
A Yes, that's possible. That's one of the items of information that we see in the literature which we believe requires further confirmation before it can be generally accepted.
Q Is the analysis of the salt concentration in urine a difficult chemical process?
A Not to a well-trained chemist or to a well-trained chemical technician.
Q Don't you think that someone who was an assistant with Thomas for 6 years in Leipzig was capable of carrying out such an analysis.
A Yes.
Q I asked this question because that is the case with my associate in the experiments. Does not a slight elimination or urine lead to the concentration of residual nitrogen in the blood?
A That is correct.
Q Have you not ascertained, Professor, that the residual nitrogen quantities in the blood of my experimental subjects did not reach any alarming proportions?
A That is my recollection from seeing your figures last January. I have not looked them over or seen them recently.
Q Professor, please convince yourself of that again on the basis of this booklet which will be put to you; are you not of the opinion, as is generally held to be so in literature, that the juvenile organism contains more water than the adult organism?
A Yes. Will you please indicate in this booklet where I can find the figures on non-protein nitrogen?
Q The residual nitrogen values are carried continuously here with the various dates; every two days the residual nitrogen was measured and the word "Blut" (blood) is next to that figure? On the 28th and on the 30th, these are the points where the experiments reached their maximum, and here the residual nitrogen quantities are given, and you will find that in only a few cases is there any increase, but none reached the point of being dangerous. Perhaps you will also observe that only the thirsting group had a certain increase, whereas the seawater group kept normal residual nitrogen values.
A Yes, that is true, with the possible exception of Subject 32.
Q Yes. In a few cases it rises above 50, but particularly in the case of the series using 500 cc seawater everything is normal. Is it not true that seawater taken from near the seacoast contains less salt then water taken from the high seas?
A Yes.
Q Do you not then consider it possible that Mediterranean searwater taken near the coast might contain a salt concentration of 2.7 per cent?
A Yes.
PROFESSOR DR. BIEGELBOECK: No further questions.
DR. STEINBAUER: (Dr. Steinbauer for Biegelboeck) BY DR. STEINBAUER:
Q Now, Professor -----
THE PRESIDENT: The defendant Biegelboeck may continue to sit by his counsel, if he desires.
Q I should like to show to you, Dr. Ivy, the document that Dr. Servatius put to you day before yesterday, Karl Brandt, 104. This is a report by a prisoner regarding a hunger experiment. I shall not put this to you in order to show that these were similar experiments, but because I want to establish certain expressions that are used in it. Let me give this document to you in the English translation.
MR. HARDY: Will Dr. Steinbauer kindly refer to the page and number of the document, what Karl Brandt document book the exhibit is contained in, and the exhibit number.
DR. STEINBAUER: It is Karl Brandt Document Book 104, and on the copy I have I should like the witness to turn to the second page where the prisoner says the following: "We all had imaginary physical, ailments and hysteria." Then five lines further on "In the cases of many persons their knees and joints swelled up to as much as three times normal in half an hour. Some of the persons fainted."
Q Doctor Ivy, does this not indicate edema resulting from hunger, this swelling of the knees and joints?
A I don't know what that means. This is an article apparently taken from "Readers Digest", which is a fiction magazine. We can't depend on the authenticity of statements made in such a magazine or on their scientific accuracy. The writers for this magazine are frequently paid to write in a dramatic and sensational manner for the purpose of interesting only lay readers.
DR. STEINBAUER: In that case, Professor, in view of what you have just said we shall not pursue this document further, and I shall withdraw it. I do not wish unscientific matter to be confused with scientific matter.
I have no further questions.
THE PRESIDENT: Defendant Biegelboeck will resume his place in the box.
I understand Dr. Tipp desires to propound some questions to the witness.
Does Dr. Tipp desire his client to sit beside him during the crossexamination, or is it unnecessary.
DR. TIPP: It is not necessary, Your Honor.
BY DR. TIPP:
Q Professor Ivy, if I have understood you correctly you said in your direct examination that the consumption of large amounts of seawater for long periods of time can lead to serious injury and to death; did I understand you correctly?
A Yes.
Q You spoke also of Berkatit, that is, the drug to make seawater potable, and told the Tribunal that seawater treated with Berkatit was identical in its practical effects with pure seawater; did I understand you correctly in this?
A Yes.